Depression

Working in
partnership with psychiatrists and carers

Introduction

anyone who gives practical help and support, without payment,
to a relative, partner or friend with depression (referred to as
'carers' in this leaflet)

any professional - psychiatrists, GP, or other member of the
health team - involved in the care and treatment of someone with
depression.

It looks at ways of encouraging clearer
communication and better collaboration between patients, carers and
professionals.

For the carer

About depression

Most of us feel sad and miserable at times,
but when these feelings last more than a few weeks, and are so bad
that they interfere with the person’s everyday life, professional
help is usually needed.

Changes in the person’s behaviour

As a carer, you may notice that the
person:

is unhappy most of the time

has lost confidence in themselves

expresses feelings of guilt, shame and worthlessness

is irritable and, perhaps angry

is tearful

has lost their appetite, or eats more than usual

has changed their sleeping pattern

is extremely tired

has problems concentrating

looks and feels anxious

is withdrawn and has lost interest in life, including sex

isn't looking after themselves as well as usual

talks of suicide.

Making a diagnosis

The professional – a doctor, nurse or social
worker – needs to understand both recent events and what has
happened to someone in the past. To do this, they need to talk to
both the patient and, often, a close relative or friend. After
considering all other possible causes of the symptoms, including
physical health problems, a diagnosis of mild, moderate or severe
depression may then be made.

Treatment

Depression is a disorder that can be helped
successfully. It can be triggered by life-events, or may appear
suddenly with no apparent cause. Most people with depression are
treated by their GP. Some may need more specialist help and may be
referred to a psychiatrist and/or to a Mental Health
Team/Service, where they could see a community psychiatric nurse
(CPN), social worker, psychologist or occupational therapist.
Admission to hospital is only needed for about 1 in a 100 people
with depression.

As a carer, how can you help your friend or relative?

Try to be a good listener – even if you hear the same thing
several times.

Remind them that depression is treatable and is not their
fault.

Keep reassuring them that they will get better.

Encourage them to get some regular exercise and to eat a
balanced diet.

Encourage them to accept professional help.

Help them to stay away from alcohol.

Take them seriously if they talk about feeling hopeless or
harming themselves.

As a carer, you may feel:

impatient with the person’s behaviour

worried about:

losing the person you knew

coping and asking for help

the future, including money problems

stigma – what other people might be thinking
or saying

the person’s safety and the risk of
suicide

exhausted by listening and caring

isolated from your other friends and contacts.

Caring for someone with depression can be
difficult, stressful and lonely, but help and support are
available.

Tips for carers

In partnership with your doctor and members of the
health team

It's important that there is clear, regular
communication between the doctor, other professionals, the person
with depression and their carer. It doesn't happen automatically,
and will take time and effort. For instance, if you really feel
that you need more time than usual to talk about what is happening
with your GP, you can book a double appointment which will give you
more time.

Decision-making/partnership

People have different views about how much
they want to be involved in making decisions about their care and
treatment. Some people are happy to leave it to the doctor, some
people like to make the decision for themselves, and others prefer
a collaboration of some sort. Whatever the patient's 'decision
preference', they and their carer should be as involved as they
want to be in any discussions about treatment or care plans. A
vital part of this is that you and your friend or relative get all
the information you need to make the decisions you need
to.

Making a trusting relationship with all the
staff involved really helps. The staff get a clearer picture of
what is happening – and how much help and support you can offer.
You get a clearer idea of the choices available and what to expect
– and how you can get some support yourself. This of great
benefit, particularly in the provision of on-going support and
information.

Questions to ask the doctor

Can you explain what the
diagnosis means?

What
can we expect in the near future and over time?

What
treatments are available?

Why have you chosen this
particular treatment?

How
long will it take for the medication to work?

How
long will the person have to take the medication?

What are the possible side-effects - and how common (or
uncommon) are they?

Would
talking therapies or CBT be helpful?

How
often should the person come to see you?

Are
there things we can do to help ourselves?

Is it
safe for the person to drive?

Do you have any written material about depression and
its treatment? If not, who does?

Are
there any organisations or local community services that may be of
help?

Who
do we contact if we need help 'out of hours'?

* Remember to arrange the next
appointment before you leave.

Regular and well prepared visits to the
doctor, or with other members of the mental health team, will
make sure that you both get the best care and support.

Planning for a follow-up visit:

Discuss any new worries or changes in mood, thoughts and
behaviour.

Keep a note of these changes as they happen, with the
dates.

Keep a note of any reactions to medication, again with the
dates if possible.

Just before the next visit, look at your notes and decide, with
your friend or relative, the most important points.

Write down your top three concerns to make sure that you
discuss these, and take the other notes with you. These could
include:

changes in symptoms and
behaviour

side-effects of medication

general physical health, e.g.
putting on or losing weight

your own health as a carer

any extra help you need

when the person will be fit to
return to normal activities, including work and driving.

During the visit:

If either of you do not understand something, ask questions
until you do.

Encourage your friend or relative to tell the professional
about how they feel.

Take notes of what you are told. At the end, tell the doctor
what you and the person have understood, so that any
misunderstandings or omissions can be cleared up.

Confidentiality

All professionals working in mental health
services have a duty of confidentiality. This means that, unless
there are exceptional circumstances, they cannot release
information about a patient without the patient's consent.

This means that professionals can sometimes be
uneasy about sharing such information with a carer – or even refuse
to do so at all.

Even if the patient has not consented to sharing their personal
information, professionals can give carers general information on
conditions, rights and services, as long as the information
provided does not breach confidentiality.

If the doctor is unwilling to involve you as a carer,
there are a number of things you can do:

ask the person you are caring for if you can stay with them at
some of their appointments, or for part of their appointment

talk to other members of the health team

contact the helplines listed at the end of this leaflet

involve local mental health advocacy workers.

Don’t forget to take care of yourself:

Share your worries with trusted friends and family members –
but do respect the patient's right to privacy.

Don’t struggle on alone, do ask for help when you feel you need
it.

Make time for yourself and leisure activities.

Make sure you eat well and get enough exercise.

Go and see your own doctor if you find it hard to sleep or are
anxious or depressed.

Ask if a family support worker is available.

Tips for professionals

The assessment

You can see the patient and the carer separately, as well as
together.

Is there enough time to?

Listen, ask, listen?

Obtain a life history?

Ask about any bereavements, possible abuse,
or other traumatic events?

Explain how you arrived at the
diagnosis?

Talk about short- and long-term
prognoses?

Leave time for questions and discussion?

In the management of depression do you?

Discuss all possible treatments including medical,
psychological and self-help?

Talk about the possible side-effects of medication?

Discuss how to meet the care needs of both the patient and the
carer?

Talk about positive outcomes?

Spend time asking about the carer’s physical and emotional
health?

Points to remember

The carer may be in need of respite.

Make it clear that you will be happy to talk to other members
of the family.

Make sure there is a professional available whom the family can
contact during working hours.

Give an ‘out of hours’ telephone number.

Make sure that the patient and carer have the information they
need about:

their care and treatment

the whole range of local services
available – exercise, nutrition or self-help groups, for
example

depression and its treatment

relevant mental health or carer
organisations.

Do send copies of letters to the patient and the carer.

Further help

Carers Trust is a charity which was formed by the merger of
The Princess Royal Trust for Carers and Crossroads Care in April
2012. Carers Trust works to improve support, services and
recognition for anyone living with the challenges of caring,
unpaid, for a family member or friend who is ill, frail, disabled
or has mental health or addiction problems. With their Network
Partners, they aim to ensure that information, advice and
practical support are available to all carers across the UK.

This leaflet was produced as part of the
Partners in Care campaign, a joint initiative between the Royal
College of Psychiatrists and The Princess Royal Trust for Carers.
One of the aims of the Partners in Care campaign was to show that
if all
those involved in the care of people with mental health problems or
learning disabilities can work together, a trusting partnership can
be developed between carers, patients and professionals which will
be of benefit to all.

Original author: Jill Siddle

User and carer input: members of Depression Alliance
Editor: Dr Philip Timms, chair, Royal College of Psychiatrists'
Public Engagement Editorial Board